Cardiac valve replacement in the elderly: a review of 320 consecutive cases

Cardiac valve replacement in 320 consecutive elderly patients (age 65 years and older) was examined retrospectively to determine the results of valvular replacement. From January 1966 to August 1979, 336 valve prostheses (146 mechanical and 190 porcine) were implanted in 320 patients (mean age 68.9 years, range 65-85 years). There were 190 aortic valve replacements (AVR), 116 mitral replacements (MVR) and 16 multiple valve replacements (MR). There were 178 patients ages 65-69 years, 114 patients ages 70-74 years, and 28 patients ages 75 years and older. Twenty (6.3%) had had previous cardiac surgery. Aortocoronary bypass was performed in 59 (18.4%). Twenty-eight patients (8.75%) died in the hospital (AVR 4.7%, MVR 11.4%, MR 37.5%). The mean follow-up was 30.2 months (total 735 patient-years). There were 92 late deaths, or 12.5% per patient year (AVR 11.3%, MVR 14.9%, MR 20.0%). Actuarial survival for all patients at 5 years was 49 +/- 7.6% (AVR 56 +/- 9.7%, MVR 47 +/- 12.5%). Survival at 24 months was 72 +/- 6.3% for ages 65-69 years, 66 +/- 9.2% for ages 70-74 years and 81 +/- 16% for patients 75 years and older. Valve-related complications were infective endocarditis (three mechanical and five porcine), periprosthetic leak (five mechanical and one porcine), valve dysfunction (12 mechanical) and thromboembolism (18 mechanical and seven porcine). At follow-up, 93.2% of surviving patients were in New York Heart Association functional class I or II.